Booby Traps Series: Moms with breastfeeding pain suffer when providers don’t know how to help

Pain with breastfeeding is a leading cause of early weaning. So when moms are in pain and turn to a health care provider, what kind of help do they get?

According to a recent study, it’s often not great.

Research from several studies has shown that obstetricians and pediatricians get poor training in breastfeeding management, and lack confidence in their ability to help nursing moms.

One study found that 67% of pediatricians and 39% of obstetricians don’t feel very confident in their skills at resolving problems with breast pain or cracked or painful nipples. Significant numbers said they weren’t very confident in their skills at teaching mothers about basic breastfeeding techniques such as positioning. And 51% of pediatricians and 26% of obstetricians report not feeling very confident of their knowledge of what referral services exist for breastfeeding support.

Some new and especially interesting evidence of the problem comes from a study published last year. It provides a glimpse into how some providers support moms suffering from pain, and it’s not pretty.

The study, conducted at a large Southern obstetrical practice, reviewed the charts of 117 breastfeeding moms who sought help for breastfeeding pain of different kinds. Mothers asked for help for mastitis (68%), candida (32%), engorgement (18%), nipple tenderness (8%), and clogged milk ducts (5%).

The results of the chart review?

Inadequate breastfeeding support and management were evident.

Non-evidence-based recommendations were routinely practiced.

There was little documentation of breastfeeding support beyond prescribing medications, and non-pharmacological measures (such as education and help with latch and positioning) were rarely recommended.

There were few referrals were documented to specialized providers such as lactation consultants or community support groups.

The area in which the advice appeared poorest was in support for women experiencing engorgement.

I asked the study’s author about evidence that providers were helping mothers with the basics of breastfeeding – latch and positioning – which can eliminate pain in many women. She said that there was no indication that anyone was helping with latch and positioning except in the case of mastitis, and that the amount of hands-on assistance was “non-existent.” Of course, it’s possible that help was being provided but not documented, but having worked in hospital and pediatric settings it would be a bit surprising to me if the providers took the time to give this kind of assistance and didn’t record it.

I was lucky enough to find an IBCLC when looking for lamaze classes while pregnant. The lamaze series offered a breastfeeding class, and the IBCLC took private clients as well as worked with a pediatricians office in my area. I chose my pediatrician based on the access to an IBCLC that my insurance would have to cover! My pediatrician, however, can barely SAY the word breast and since he is a male definitely had no advice for me. The lactation educators at the hospital actually had no education or training beyond working in the lactation gift shop and made recommendations that actually hindered breastfeeding success, so there was horrific support from the beginning. My son was also born on a holiday weekend so thank goodness for sites like Kellymom.com, lowmilksupply.org and youtube or I would have given up! Best advice I got was that if it hurt then something was wrong and to ask for help.

My daughters dr told me ” I would have to tuff it out” pertaining to our infection with yeast. If this was not my first child I would have caved. I am still battling a yeast infection (the last 4 wks). It is very frustrating to deal with a clueless OB who is prescription happy and a childrens DR who thinks I need to better cope with BF pain. arghh

I think it’s important as part of this, care providers learn more about diagnosing and treating tongue and lip ties, which can cause bf pain and early weaning (among other things). Yet they are very rarely even looked for or mentioned to parents as a possible cause of problems and even when they are, many providers don’t know what to look for.

When I was nursing my youngest I started having breast pain (I had nursed 3 babies, so I was not new to nursing). I knew I was getting Mastitis, and called the advice nurse with Kaiser, to get a doctors appointment and some antibiotic. They told me I would be fine to try to rest and nurse more. They told me to call back if it got worse. When I woke up in the morning I had 103 degree fever, and my infected breast hurt so bad I thought I was gonna die. I’ve never been that sick in my life. I had to call back again before to took me seriously. I’m still mad that they wern’t more proactive when I first called with the problem. I was a pro- nurser by then, but if I was new to the whole thing I probably would have stopped nursing. Leah was 5 months old at the time, and I continued nursing until she was 16 months.